Troponin I potential in assessing the unfavorable outcome risk in patients with cardiovascular diseases

Aim. To analyze the associations of high-sensitivity cardiac troponin I (hs-cTnI) levels with outcomes in patients with cardiovascular diseases and to evaluate its prognostic capability for adverse cardiovascular events. Materials and methods. The study included 10688 people aged 35-64 years (59,3% women) who were participants in the ESSE-RF and ESSE-RF2 multi-center observational studies, who had data on the hs-cTnI level. The hs-cTnI level in the specimens was determined with chemiluminescence microparticle immunoassay. From the total sample, groups of people with a coronary artery disease or myocardial infarction (CAD+MI group) and a cerebrovascular accident (CVA group) were identified. The following composite endpoint was chosen: cardiovascular death, non-fatal MI, or non-fatal stroke. The median follow-up period was 7,5 years. Results. A higher hs-cTnI level was associated with an increased likelihood of composite endpoint both in the population sample as a whole (odds ratio (OR)=1,51; 95% CI 1,29-1,79, p<0,001) and in the groups of CAD+MI (OR=1,54; 95% CI 1,23-1,92, p<0,001) and stroke (OR=3,52; 95% CI 1,97-6,29, p<0,001). The threshold values of 4 pg/ml for women and 6 pg/ml for men make it possible to predict adverse outcomes in the groups of CAD+MI and stroke (Area Under the Curve (AUC)=0,8 and 0,89, respectively). Kaplan-Meier survival curves showed significantly lower probability of composite endpoint absence in individuals with hs-cTnI levels ³4/6 pg/ml in both study groups. Conclusion. The study data suggest that hs-cTnI is a promising prognostic biomarker in groups of patients with cardiovascular disease. The selected threshold values make it possible to estimate the probability of an unfavorable outcome in patients CAD, MI, and stroke with high sensitivity and specificity.